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Leclerc J, Poirier P. Corporate Lobbyists: Open Season on Academic Health Science? Can J Cardiol 2020; 37:182-183. [PMID: 32376284 DOI: 10.1016/j.cjca.2020.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jacinthe Leclerc
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Canada; Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada; Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada.
| | - Paul Poirier
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada; Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada
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Leclerc J, Blais C, Rochette L, Hamel D, Guénette L, Beaudoin C, Poirier P. Public Health Outcomes May Differ After Switching from Brand-Name to Generic Angiotensin II Receptor Blockers. Drugs R D 2020; 20:135-145. [PMID: 32342284 PMCID: PMC7221012 DOI: 10.1007/s40268-020-00307-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background It is unclear whether generics are as safe as brand-name drugs in cardiology. For public health surveillance purposes, we evaluated if switching from the brand-name losartan, valsartan, or candesartan impacted the occurrence of the following outcomes: emergency room (ER) consultations, hospitalizations, or death. Study Design This was a retrospective cohort study. Methods This study was conducted in the Quebec Integrated Chronic Disease Surveillance System, including healthcare administrative data of the population of Quebec, Canada. We included brand-name users of losartan, valsartan, or candesartan aged ≥ 66 years who had undergone ≥ 30 days of stable treatment on the brand-name drug prior to cohort entry (substitution time-distribution matching was used to prevent immortal time bias). Outcomes up to 1 year were compared between groups using multivariable Cox proportional hazards regression models (validity assumptions were verified). Results In our cohorts (losartan, n =15,783; valsartan, n =16,907; candesartan, n =26,178), mean age was 76–78 years, 59–66% were female, 90–92% had hypertension, and 13–15% had heart failure. Validity assumptions were violated for losartan only. For patients switched to generic valsartan, the hazard ratio (95% confidence interval) was 1.07 (0.99–1.14) for ER consultation, 1.26 (1.14–1.39) for hospitalization, and 1.01 (0.61–1.67) for death. The corresponding rates for candesartan were 1.00 (0.95–1.05), 0.96 (0.89–1.03), and 0.57 (0.37–0.88), respectively. Conclusions We observed an increased risk of hospitalizations for patients switched to generic valsartan, and a decreased risk of death for patients switched to generic candesartan, compared with those who continued taking the brand-name drug. The differences between generic and brand-name drugs may lead to some differences in public health outcomes, but this safety signal must be further studied using other cohorts and settings. Electronic supplementary material The online version of this article (10.1007/s40268-020-00307-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jacinthe Leclerc
- Institut national de santé publique du Québec, Bureau d'information et d'études en santé des populations, Quebec, QC, Canada. .,Département des Sciences infirmières, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Local 4849, Santé, Trois-Rivières, QC, G9A 5H7, Canada. .,Faculty of Medicine, McGill University, Montreal, QC, Canada.
| | - Claudia Blais
- Institut national de santé publique du Québec, Bureau d'information et d'études en santé des populations, Quebec, QC, Canada.,Faculté de Pharmacie, Université Laval, Quebec City, QC, Canada
| | - Louis Rochette
- Institut national de santé publique du Québec, Bureau d'information et d'études en santé des populations, Quebec, QC, Canada
| | - Denis Hamel
- Institut national de santé publique du Québec, Bureau d'information et d'études en santé des populations, Quebec, QC, Canada
| | - Line Guénette
- Faculté de Pharmacie, Université Laval, Quebec City, QC, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Quebec City, QC, Canada
| | - Claudia Beaudoin
- Institut national de santé publique du Québec, Bureau d'information et d'études en santé des populations, Quebec, QC, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Quebec City, QC, Canada.,Faculté de médecine, Université Laval, Quebec City, QC, Canada
| | - Paul Poirier
- Faculté de Pharmacie, Université Laval, Quebec City, QC, Canada.,Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, QC, Canada
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Are Generic Drugs Used in Cardiology as Effective and Safe as their Brand-name Counterparts? A Systematic Review and Meta-analysis. Drugs 2020; 80:697-710. [PMID: 32279239 DOI: 10.1007/s40265-020-01296-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Previous systematic reviews (2008; 2016) concluded similarity in outcomes between brand-name and generic drugs in cardiology, but they included ≥ 50% comparative bioavailability studies, not designed or powered to detect a difference in efficacy or safety between drug types. We aimed to summarise best-evidence regarding the effectiveness and safety of generic versus brand-name drugs used in cardiology. METHODS For this systematic review of the literature, scientific databases (MEDLINE and EMBASE) were searched from January 1984 to October 2018. Original research reports comparing the clinical impact of brand-name versus generic cardiovascular drugs on humans treated in a real-life setting, were selected. Meta-analyses and subgroup analyses were performed. Heterogeneity (I2) and risk of bias were tested. RESULTS Among the 3148 screened abstracts, 72 met the inclusion criteria (n ≥ 1,000,000 patients, mean age 65 ± 10 years; 42% women). A total of 60% of studies showed no difference between drug types, while 26% concluded that the brand-name drug was more effective or safe, 13% were inconclusive and only 1% concluded that generics did better. The overall crude risk ratio of all-cause hospital visits for generic versus brand-name drug was 1.14 (95% confidence interval: 1.06-1.23; I2: 98%), while it was 1.05 (0.98-1.14; I2: 68%) for cardiovascular hospital visits. The crude risk ratio was not statistically significant for randomised controlled trials only (n = 4; 0.92 [0.63-1.34], I2: 35%). CONCLUSION The crude risk of hospital visits was higher for patients exposed to generic compared to brand-name cardiovascular drugs. However, the evidence is insufficient and too heterogeneous to draw any firm conclusion regarding the effectiveness and safety of generic drugs in cardiology.
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